Nokea
A patient has undergone a laparoscopic cholecystectomy and is being prepared for discharge home. When providing health education, the nurse should prioritize which of the following topics?
- A. Management of fluid balance in the home setting
- B. The need for blood glucose monitoring for the next week
- C. Signs and symptoms of intra-abdominal complications
- D. Appropriate use of prescribed pancreatic enzymes
Correct Answer: C
Rationale: Because of the early discharge following laparoscopic cholecystectomy, the patient needs thorough education in the signs and symptoms of complications. Fluid balance is not typically a problem in the recovery period after laparoscopic cholecystectomy. There is no need for blood glucose monitoring or pancreatic enzymes.
You may also like to solve these questions
A patient is being treated on the acute medical unit for acute pancreatitis. The nurse has identified a diagnosis of Ineffective Breathing Pattern Related to Pain. What intervention should the nurse perform in order to best address this diagnosis?
- A. Position the patient supine to facilitate diaphragm movement.
- B. Administer corticosteroids by nebulizer as ordered.
- C. Perform oral suctioning as needed to remove secretions.
- D. Maintain the patient in a semi-Fowlers position whenever possible.
Correct Answer: D
Rationale: The nurse maintains the patient in a semi-Fowlers position to decrease pressure on the diaphragm by a distended abdomen and to increase respiratory expansion. A supine position will result in increased pressure on the diaphragm and potentially decreased respiratory expansion. Steroids and oral suctioning are not indicated.
A nurse is caring for a patient who has been scheduled for endoscopic retrograde cholangiopancreatography (ERCP) the following day. When providing anticipatory guidance for this patient, the nurse should describe what aspect of this diagnostic procedure?
- A. The need to protect the incision postprocedure
- B. The use of moderate sedation
- C. The need to infuse 50% dextrose during the procedure
- D. The use of general anesthesia
Correct Answer: B
Rationale: Moderate sedation, not general anesthesia, is used during ERCP. D50 is not administered and the procedure does not involve the creation of an incision.
A patient who had surgery for gallbladder disease has just returned to the postsurgical unit from postanesthetic recovery. The nurse caring for this patient knows to immediately report what assessment finding to the physician?
- A. Decreased breath sounds
- B. Drainage of bile-colored fluid onto the abdominal dressing
- C. Rigidity of the abdomen
- D. Acute pain with movement
Correct Answer: C
Rationale: The location of the subcostal incision will likely cause the patient to take shallow breaths to prevent pain, which may result in decreased breath sounds. The nurse should remind patients to take deep breaths and cough to expand the lungs fully and prevent atelectasis. Acute pain is an expected assessment finding following surgery; analgesics should be administered for pain relief. Abdominal splinting or application of an abdominal binder may assist in reducing the pain. Bile may continue to drain from the drainage tract after surgery, which will require frequent changes of the abdominal dressing. Increased abdominal tenderness and rigidity should be reported immediately to the physician, as it may indicate bleeding from an inadvertent puncture or nicking of a major blood vessel during the surgical procedure.
A patient with pancreatic cancer has been scheduled for a pancreaticoduodenectomy (Whipple procedure). During health education, the patient should be informed that this procedure will involve the removal of which of the following? Select all that apply.
- A. Gallbladder
- B. Part of the stomach
- C. Duodenum
- D. Part of the common bile duct
- E. Part of the rectum
Correct Answer: A,B,C,D
Rationale: A pancreaticoduodenectomy (Whipple procedure or resection) is used for potentially resectable cancer of the head of the pancreas. This procedure involves removal of the gallbladder, a portion of the stomach, duodenum, proximal jejunum, head of the pancreas, and distal common bile duct. The rectum is not affected.
A patient with a cholelithiasis has been scheduled for a laparoscopic cholecystectomy. Why is laparoscopic cholecystectomy preferred by surgeons over an open procedure?
- A. Laparoscopic cholecystectomy poses fewer surgical risks than an open procedure.
- B. Laparoscopic cholecystectomy can be performed in a clinic setting, while an open procedure requires an OR.
- C. A laparoscopic approach allows for the removal of the entire gallbladder.
- D. A laparoscopic approach can be performed under conscious sedation.
Correct Answer: A
Rationale: Open surgery has largely been replaced by laparoscopic cholecystectomy (removal of the gallbladder through a small incision through the umbilicus). As a result, surgical risks have decreased, along with the length of hospital stay and the long recovery period required after standard surgical cholecystectomy. Both approaches allow for removal of the entire gallbladder and must be performed under general anesthetic in an operating theater.